Monday, 2-27-Pap smear, cervical dysplasia, and cancer (Wootton) Flashcards Preview

Repro 2-Final > Monday, 2-27-Pap smear, cervical dysplasia, and cancer (Wootton) > Flashcards

Flashcards in Monday, 2-27-Pap smear, cervical dysplasia, and cancer (Wootton) Deck (18):
1

site where greater than 90% of cervical neoplasias arise?

Squamocolumnar junction

2

the majority of cervical cancers and CIN are caused by these HPVs?

HPV 16 and 18 responsible for ~70% of cervical CA

3

Risk factors for cervical neoplasia?

-more than 1 sexual partner or male sexual partner who has had sex with >1 person
-young age at 1st intercourse or pregnancy
-smoking
-HIV
-organ transplant
-STIs
-DES exposure
-infrequent or absent pap screening tests
-high parity
-lower SES

4

PAP screening guidelines for under 21 yrs?

No screening

5

PAP screening guidelines for age 21-29?

cytology alone every 3 yrs

6

PAP screening guidelines for ages 30-65?

HPV and cytology "cotesting" every 5 yrs (preferred)

7

PAP screening guidelines for 65+?

no screening following adequate negative prior screening

8

PAP screening after hysterectomy?

no screening

9

what is the next step in management of Atypical Squamous cells of undetermined significance (ASC-US)?

-HPV testing (preferred) ---> if HPV + ---> Colposcopy --> manage per ASCCP guideline

-Repeat cytology (@1 yr acceptable) --> If more ASC ---> colposcopy --> manage per ASCCP guidelines

10

what is the next step in management of women with LSI with negative HPV OR no HPV test done OR with + HPV test?

colposcopy

11

gold standard for Dx and tx planning in cervical CA?

colposcopy

-must visualize entire squamocolumnar junction
-look for acetowhite changes, punctuations, mosaicism, abnormal vessels, masses (in order of severity of disease)
-directed biopsies and endocervical curettage

12

when are excisional techniques utilized for tx of cervical CA?

-endocervical curettage is postiive (needs cold knife cone)
-unsatisfactory colposcopy (No SCJ)
-substantial discrepancy between pap and biopsy (i.e., high grade pap and neg. colposcopy)

13

risks of excisional procedures?

-INCREASED RISK OF PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM)
-OPERATIVE RISKS-BLEEDING, INFX
-increased risk of cervical incompetence and resultant 2nd trimester pregnancy loss
-cervical stenosis

14

91% of cervical CA is caused by HPV and 80% of cases are ___ carcinomas

squamous cell

-adenocarcinoma/adenosquamous make up 15%

15

for clinical evalulation of cervical neoplasia:

-symptoms?

-spread?

-staging?

symptoms: watery vaginal bleeding, postcoital bleeding, intermittent spotting

spread: direct invasion and lymphatic spread

staged: clinically (PE, radiology-chest and skeletal xrays, IVP; cytoscopy; sigmoidoscopy, LFTs

16

how to prevent cervical CA?

-abstinence/limit # partners
-USE OF BARRIER PROTECTION
-regular exams and pap smears
-VACCINATION with THE HPV VACCINE

17

how is HPV vaccine administered? recommendation for who?

1st dose, 2nd dose 2 months later, 3rd dose 6 months from 1st

all girls and boys ages 9-26

18

side effects of gardasil?

-syncope
-DIZZINESS
-nausea
-HEADACHE
-Fever
-INJX SITE RXNS (PAIN, SWELLING, REDNESS)